Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Surgery, CHA Ilsan Medical Center, CHA University, Goyang, South Korea.
Department of Breast Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Breast. 2020 Oct;53:85-91. doi: 10.1016/j.breast.2020.06.009. Epub 2020 Jul 3.
Nipple-sparing mastectomy (NSM), followed by immediate reconstruction (IR) of the breast, has become a preferred surgical procedure with good cosmesis results and patient satisfaction. However, nipple-areolar complex (NAC) ischemia and necrosis remain major problems after NSM and IR.
We retrospectively analyzed patients who underwent NSM and IR at Gangnam Severance Hospital from January 2009 to June 2018. We compared the patient characteristics and complication rate among three different incisions (inframammary fold [IMF], radial, periareolar). Additionally, we identified the risk factors of NAC necrosis.
Data from 290 eligible breasts in 275 patients were analyzed. Patients with IMF incision had relatively lower breast weights. The overall complication rate was the highest with periareolar incision and the lowest with IMF incision (42.6% vs. 18.8%, p < 0.001). The rate of NAC ischemia or necrosis was significantly different among the three incisions (9.7%, 17.0%, and 31.1% in IMF, radial, and periareolar, respectively; p < 0.001). Moreover, surgical treatments were more frequently needed in patients with periareolar incision. Periareolar incision, short distance from the tumor to the nipple base, and large breast weight were independent risk factors of NAC ischemia or necrosis in multivariable analysis.
Compared with IMF incision, periareolar incision was associated with higher incidences of surgical complications and NAC necrosis. Careful consideration is needed when planning NSM in patients with a large breast volume or a tumor close to the nipple.
保留乳头乳晕的乳房切除术（NSM）联合即刻乳房重建（IR）已成为一种具有良好美容效果和患者满意度的首选手术方法。然而，NSM 和 IR 后乳头乳晕复合体（NAC）缺血和坏死仍然是主要问题。
我们回顾性分析了 2009 年 1 月至 2018 年 6 月在江南三星医院接受 NSM 和 IR 的患者。我们比较了三种不同切口（乳晕下、放射状、乳晕周围）的患者特征和并发症发生率。此外，我们还确定了 NAC 坏死的危险因素。
纳入 275 例患者的 290 个乳房进行分析。IMF 切口组患者乳房重量相对较轻。乳晕周围切口组的总并发症发生率最高，IMF 切口组最低（42.6% vs. 18.8%，p<0.001）。三种切口的 NAC 缺血或坏死发生率有显著差异（IMF、放射状和乳晕周围切口分别为 9.7%、17.0%和 31.1%；p<0.001）。此外，乳晕周围切口组需要手术治疗的患者比例更高。多变量分析显示，乳晕周围切口、肿瘤距乳头基底的距离较短和乳房较大是 NAC 缺血或坏死的独立危险因素。
与 IMF 切口相比，乳晕周围切口与更高的手术并发症和 NAC 坏死发生率相关。对于乳房体积较大或肿瘤靠近乳头的患者，在计划 NSM 时需要慎重考虑。
